The Green House!!

We are enjoying our stay at the "Green House", named after the color of its keyrings, which is one of the guest houses at Kibogora. There are 4 bedrooms each with private bath, and common areas including a modest kitchen, a living room with a fireplace (not sure how often it is used!), a dining room, and an enclosed porch with a spectacular view over the mountainside with glimpses of Lake Kivu in the distance. Initially, we had planned to prepare our own meals but decided to enjoy breakfasts and dinners prepared by the kitchen along with our traditional "Clif and Earl" lunches.

When we arrived, we were warmly greeted by Bestine, one of the guesthouse workers.

During our first week, we enjoyed visiting with other guests including an orthopod and his wife from Norway and an anesthetist/nurse couple from Wisconsin. Tony the orthopod serenaded us with his ukelele!!     

           Those couples have gone home and this week, we have been joined by two general surgeons from New Hampshire who are busy with endoscopies.

The temps get into the mid 70s during the day and cool into the mid 60s at night - quite pleasant!! 

As it shows below, it is rainy season with periods of heavy rain each day!!!

RWANDA

 Rwanda is a landlocked country lying just below the Equator in East Africa surrounded by Uganda to the north, Tanzania to the east, Burundi to the south, and Congo to the west. It is called the “land of a thousand hills” due to its mountainous nature – the lowest point in the country is 3100 feet above sea level. It’s area is about 10,000 square miles, about the size of Massachusetts.

Rwanda is densely populated with about 14 million people. The capital city of Kigali is located in the center of the country and has a population of about 600,000; it is said to be the cleanest large city in Africa!!    The life expectancy for men is 67 and 71 for women. Around three quarters of the people are literate.  Over 90 percent are Christian, due to the influence of both Protestant and Catholic missionaries.

The weather in Rwanda is temperate with two rainy seasons: February through June and September through December.

The economy of Rwanda is primarily agricultural. Coffee is the main agricultural export.

Healthcare in Rwanda is a decentralized universal system centered around Community-Based Health Insurance which covers most Rwandans with a sliding scale for premiums and gives all citizens access to a network of primary care centers. People needing further care can be referred to one of 42 district hospital or one of the four national referral hospitals.

Rwanda’s history is complex and we look forward to learning more of the details. Very briefly, in the late 1800s, Rwanda was colonized by Germany; Belgium took over during the first World War. The Europeans ruled by way of a Rwandan king and were partial to the Tutsi tribe. The other main tribe, the Hutus, revolted in 1959, massacred many Tutsis, and set up an independent Hutu-led republic in 1962. Ethnic tensions continued to fester and, in 1990, the Tutsi-led Rwandan Patriotic Front (RPF) launched a civil war. Tensions continued and, in April 1994, there was a 3 month genocide in which over a half million were killed, primarily Tutsis. This genocidal killing stopped when the Tutsi-led RPF gradually took control of the country. Today, the country is led by Paul Kagame, an early leader of the RPF. 

...we'll be at Kibogora Hospital in far southwestern Rwanda, near Lake Kivu! It is 100 miles and a 5 hour car ride from the capital city of Kigali.

Kitchen potpourri

 

Many of the long termers here drink the water from the tap, which goes through some type of filtration process. However, we are playing it safe and boil our drinking water each day in our hotpot, storing 4 or 5 1.5 liter flasks in our fridge. Once we got used to doing this, it was not a big deal!

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           

                                                                                                                                                                

 

     Most of our food is imported:

Peanut butter (India), Skim milk (Denmark), Juice (S. Africa), Tea bags (Sri Lanka), Cookies (Germany), Corn Flakes (Ukraine !), Fig Jam (Lebanon), Canned tomatoes (Italy), Powdered milk (Canada), and Tuna (Lebanon).

In our suitcases, we "imported" American items including Old fashioned oatmeal for breakfast, Earl Grey tea and Clif Bars for lunch, and a generous supply of M and Ms.

We are not starving!!!

There is an openair market just outside the hospital gate with many vendors selling all kinds of fruit and vegetables. Since we are primarily vegetarians, this was good news!! One of our meal staples is a coleslaw that David makes from cabbage, onions, carrots, and green peppers with a simple "1-2-3" dressing we learned from Dr. Erin Meier in Papua New Guinea- one part sugar, two parts balsamic vinegar, and three parts olive oil. (if you use white balsamic vinegar, it helps prevent discoloration of the slaw after a day or two).  The "before and after" are below!!  

 

         

        

                                    

ELWA Hospital ("Eternal Love Winning Africa")

ELWA Hospital is a ministry of SIM (formerly Sudan Interior Mission) and was started in 1965 by Dr. Bob Schindler, a general surgeon from Berrien Springs, Michigan!

The hospital is on a large parcel of land that lies along a beautiful stretch of Atlantic Ocean, near Liberia's capital, Monrovia.    There are wards for Male, Female, Surgical, OB, and Pediatrics.

 

These wards all lie around a large courtyard that is well manicured with shrubs and flowers.

The mural below greets us each morning as we start our rounds. We could not reprise our 1977 photo 

because the bench was long gone!!!!

     

                                                                                                                                                                                                                                                                                                                     Typical morning scene with patients waiting for their turn.

The 3 general surgeons here all trained in the 

5 year PAACS program at Galmi

Hospital in Niger, where we have served

5 times. This is Dr. Elvis

at the nursing station. We have enjoyed 

working with him, Dr. Audry, and

 Dr. Juvenal.

   

                                                                                                        The hospital chapel is where daily 7:30 AM devotions are held.

The Chapel is dedicated to the memory of Dr. Steve Befus, who

served at ELWA for 21 years. He was a 1979 graduate of Wayne State Medical School and sadly died at a young age from lymphoma. Two of our Grand Rapids friends were in his med school class.

LIBERIA 2025!!

Liberia lies in West Africa, just north of the Equator and just east of the Prime Meridian. It is surrounded by Sierra Leone, Guinea, and the Ivory Coast.


 

......We left Grand Rapids on Saturday March 15 and arrived in Monrovia, the capital of Liberia on Sunday evening, a door-to-door journey of about 31 hours. We are serving for a month at ELWA Hospital, an 81 bed facility located about an hour outside of the capital. Things are quite different than when we first served here in 1977!!

The old hospital, started in 1965, was replaced in 2016 by a new building built by Samaritan's Purse. The radio station, which at one time broadcast throughout West Africa, now is more of a local station.

The ELWA base is right along the Atlantic Ocean and occupies a 100 acre compound that includes the Hospital, a Dental Clinic, the Radio Station, and ELWA Academy which includes grades K-12.

Our home for the next month - hot water, good kitchen, reliable electricity, and reliable internet through the cellphone carrier Orange!

 

Here is the view as we leave our front door.

The beautiful Atlantic Ocean!!! We have been to the beach several times - the waves at high tide are incredible!!         

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LIBERIA – a few facts! (thanks to Wikipedia)

**Population: 5.5 million

**Area: 43,000 square miles, slightly less than half the size of Michigan

**Language: officially English but there are about 20 indigenous languages used

**Religion: 85% Christian (various Protestant denominations and Catholic);

                     12% Muslim, 3% other

**GDP: ranks about #179 poorest out of 186 countries

**Brief history:

The American Colonization Society was formed in the US in 1816 to support

repatriation of free people of color and emancipated slaves. Some claimed that this would give them a chance for freedom and prosperity in Africa but some thought that these people might not integrate well into American society and some white Americans believed that African Americans were inferior. In any event, the African American community opposed this project, believing that what appeared to be altruism and philanthropy was actually racism.

 Between 1822 and 1861, about 15,000 freed and free-born African Americans and 3000 Afro-Caribbean people were located to Liberia. Many succumbed to tropical diseases.

 Liberia declared independence in 1847 but was not recognized by the United States until 1862; it is the oldest modern republic in Africa.

 Americo-Liberians did not integrate well with the indigenous tribes and formed a small political elite that was in control for many years. This dominance was broken in 1980 when a violent military coup ended Americo-Liberian rule and a dictator from an indigenous tribe took over. In 1990, this dictator was assassinated in the midst of a civil war which lasted until 1997 when a rebel leader was elected. A second civil war erupted in 1998 and lasted until 2003 when the rebel leader was overthrown and went into exile.

 During these coups and civil wars, about 250,000 Liberians were killed, many were displaced from their homes, and the Liberian economy tanked by 90%

 Democratic elections were finally held in 2005 and there has been political stability since.

The country was rocked again from 2014-2016 when Liberia was the epicenter of the Ebola outbreak. The 3 Americans med-evacuated to the US urgently all served at ELWA Hospital.

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Water!!!!! (Togo 2024)

 Most of us don't give a second thought to our water supply - when we turn on the faucet, we know that clean water will come out. How often we leave the water running while brushing our teeth or take long showers or fill the tub for a bath!  Such luxury!!!!

In many parts of Africa, water is neither plentiful nor clean. Waterborne illnesses like typhoid, parasites, and worms are the result, causing much disease and even death.

Mango, the town where the Hospital of Hope is located, is fortunate to have a "city water" supply. This comes from a nearby river and is filtered by the city. When it reaches HOH, it is refiltered for maximum safety. Unfortunately, the city supply can be inadequate at times. Missionaries who live off of the compound have been without water for the past three weeks. Multiple past efforts to dig an adequate well on the base have been unsuccessful. Recently, the hospital has had to go to "plan B" which involves hauling water from the nearby river in large cisterns 5 times a day, filtering it, and pumping it up to the water tower which is on the base. Then, the water reaches our taps by gravity.

This truck and 2500 gallon tank make 5 trips daily to a nearby
river to get water. Each trip takes a little over an hour!

Water from the tanks is filtered, transferred to a
holding tank, and then pumped up into the water 
tower. Amazingly, gravity passively delivers it to 
our water taps!

....at the Station

 The Station is the central area of the hospital where nurses, doctors, and PAs gather. Some are focused on the urgent care/ER department which is called "Rea" (for reanimation) while others are focused on the inpatients. There is often collaboration between these two areas. The Hospital of Hope is blessed to have many Togolese nurses who have trained at the onsite nursing school as well as some expat nurses - their level of care is excellent!!

This is the "Rea" unit which functions as an urgent care/ER
 area. Some of the team for the day is in the picture below.

At the right is Kayli, a senior med student from Texas. Next to her is Alain
who has been at HOH from its opening - he started as the hospital
administrator but later went back to Physician Assistant school so
that he could help in patient care! At the left is Mike, a nurse who has
also served here from the beginning. In back is Dr. Arung, a 
surgical resident from Cameroon who recently started his 
5 year training program.

Across the nursing station from Rea is where the 
inpatient docs work. Susie is entering progress notes
onto the computer and conferring with nurse Alassi!

We have enjoyed getting to know Kayli, who will
soon return to Texas for med school graduation.
She is going into Family Medicine and hopes to
pursue medical missions!